1. The Conceptual Basis of Traditional Chinese Medicine
One of the major assumptions inherent in traditional Chinese medicine is that disease is due to an internal imbalance of Yin and Yang; therefore disease can be treated by correcting the Yin Yang imbalance, thereby returning the body to a healthy state. Western medicine tends to approach disease by assuming that it is due to an external force, such as a virus or bacteria, or a slow degeneration of the functional ability of the body. Both Chinese and Western concepts are valid alternatives. Although this chapter is devoted to the philosophy of traditional Chinese medicine it is useful to start by examining briefly some of the assumptions and philosophies of Western medicine. This will provide a useful comparative basis which will elucidate the understanding of both systems.
Western medicine is based on the Cartesian philosophy that the body represents one functioning system and the mind another It accepts that each system may affect the other, but essentially it sees disease as either physical or mental. The Chinese assume that the body is whole, and each part of it is intimately connected. Each organ has a mental as well as a physical function, as will be discussed later.

Until fairly recently most Western doctors and pharmaceutical companies have worked on the basis that there is 'a pill for every ill'. The philosophical approach behind this idea is that an external force, or chemical, can cure disease, but although some pills are of great value, both the general public and the medical profession have become considerably more skeptical about the widespread use of such chemicals. Traditional Chinese medicine states that the body has the potential to cure its own diseases if pushed (or needled) in the correct way.

Some authors, such as Ivan Illich, have been hypercritical of Western medicine and thus some people have looked upon acupuncture as not just an alternative but a superior system of medicine. Acupuncture is just another medical system, with ideas that may be of benefit to the individual patient and Western medicine as a whole, but it cannot be promulgated as either superior or a cure all. The major disadvantage of Western medicine is that it has the potential to cause a great deal of harm. Acupuncture, on the other hand, is most unlikely to cause any serious damage as it is a particularly safe form of therapy; this is undoubtedly one of its main advantages.

Even though the traditional Chinese explanations for acupuncture are somewhat enigmatic to the Western doctor, acupuncture does seem to have a clearly validated scientific basis. In spite of their radically different philosophical assumptions it is wiser to look at these two medical systems as mutually beneficial, rather than mutually exclusive. Each system has ideas and therapeutic methods that can be explained both scientifically and philosophically, each can benefit the individual, and together they can broaden the philosophical and ideological basis of medicine.

The Balance of Nature
The Chinese believe that health is achieved, and disease prevented, by maintaining the body in a 'balanced state'. This concept was applied to both individuals and society at large. In individual terms the ancient Chinese physicians preached moderation in all things, such as alcoholic intake and gastronomic excess. They also stated that daily activities should include mental as well as physical tasks. The wealthier Chinese visited their doctor when they were well, paying a retainer to the doctor to keep them healthy. If they became ill the doctor lost his fee.

Such a highly sophisticated and personal system of health care is impracticable within the current limitations of Western society, but the concept behind such ideas represents a radically different approach to health and disease. The Chinese culture was also one of the first to grasp the potential within the broader field of preventative medicine. Many of these ideas were effected in the public health measures, which first began to be introduced during the Warring States period.

The body is a delicate balance of Yin and Yang. Yin represents water, quiet, substance and night, whilst Yang represents fire, noise, function and day. The two are polar opposites and because of this one must be present to allow the other to exist; for instance, how can you experience joy if you do not understand misery? The state of the body is determined by the balance of Yin and Yang within it. Each of the organs of the body has an element of Yin and Yang, although one organ may be more Yang in its nature, whilst the other is more Yin. One organ may be more important in its substantive form (Yin) whilst another is more important because of its functional abilities (Yang). When the healthy body is examined as a complete functioning system the Yin and Yang properties within it are in a fluctuating balance.

The balance of Yin and Yang is not always exact. Sometimes a person's mood may be more fiery, or Yang, whilst at other times he may be quieter and therefore more Yin. Normally the balance changes from hour to hour and day to day, but if the balance is permanently disordered, for instance if Yin consistently outweighs Yang, then the body is unhealthy and disease results.

The Therapeutic Application of Yin and Yang
When there is imbalance external agents can invade the body and cause disease, these external agents being called pathogens. The essential principle of Chinese traditional medicine is to decide on the exact nature of the imbalance between Yin and Yang, and the pathogen causing the trouble, and then to correct these pathological processes. As the natural forces of the body return to a normal balance the disease is then cured.

The art of traditional Chinese medicine is to particularize the imbalance accurately so that it can be corrected quite specifically The patient is then treated by using specific acupuncture points on the body, or the ear, in order to re-balance the body. This broad system of traditional medicine applies to all aspects of

therapy used by the ancient Chinese, particularly acupuncture and herbal medicine.

The diagnostic and therapeutic principles of Yin and Yang and the pathogens are based on a system of anatomy and physiology peculiar to traditional medicine. The anatomy of traditional medicine is represented by the acupuncture points and the channels that connect them. The physiology is represented by the organ functions that are outlined in the Nei Ching Su Wen,1 and will be discussed later in this chapter.

The Anatomy of Traditional Chinese Medicine
The channels are a system of conduits that carry and distribute Qi, or vital energy, throughout the body. Each of the organs of the body is represented by a channel, and diseases of a particular organ can be treated by using acupuncture points on the channel representing that organ.

Disease is present when the flow of vital energy through the channels is disrupted. This may occur when the integrity of the channels themselves is damaged by a sprain or strain. The Chinese describe this as a disease of 'Bi', or pain, caused by a localized disruption to the flow of Qi. The flow of Qi through the channels may also reflect the result of internal disease; for instance, if there is a disease of the liver then the flow of Qi through the liver channel will be abnormal.

The concept of channels exists exclusively in traditional Chinese medicine. Many of the facts handed down to us by the ancient Chinese do seem to have scientifically explicable reasons, but their ideas about the channels have eluded any explanation, so far. A variety of research workers have tried to correlate the channels with nerve pathways or muscle groups in the body, but all these explanations are inadequate. In spite of their elusiveness the channels represent a practical working system for acupuncture and are therefore still useful.

Acupuncture points are quite specific areas on the channels. They represent points of maximum influence on the flow of vital energy, or Qi, through the channels. This can be demonstrated clinically by thinking about the disease process that occurs when someone tears a muscle. The traditional Chinese explanation for

this disorder is that the channel running through the damaged muscle has been physically disrupted, resulting in local pain, a disease of Bi. In order to treat the pain, the integrity of the channel and the flow of vital energy through the channel, must be restored. This can be achieved by the selective use of acupuncture points on the damaged channel, which restores the flow of Qi and relieves the pain.

If the internal balance of Yin and Yang is seriously disrupted (so that disease results), then there will be an abnormal flow of Qi, or vital energy, through the channel representing the diseased organ. The diseased organ must be diagnosed and then acupuncture points can be selected from the relevant channel. The use of these specific acupuncture points corrects the flow of Qi in the channel and this, in turn, has an effect on the diseased internal organ. The overall result of this therapy is to correct the imbalance within the body, and thus heal the disease; an internal disease can therefore be treated by external means.

The Chinese Biological Clock
Vital energy flows through the channels in a well defined circadian rhythm.
As the diagram overleaf shows, vital energy, or Qi, flows through the stomach channel in the early part of the day. A recent French survey showed that an accident driving to work is much more likely if breakfast has been missed. The ancient Chinese would explain this by saying that the energy required by the stomach, during the morning, has not been absorbed and therefore the body is not in a healthy state because it has 'missed breakfast'. Perhaps the idea of a large English breakfasts is more healthy than previously supposed.

The lung channel is dominant between 3.00 a.m. and 5.00 a.m. If there is a disease of the lung it should manifest itself at these times, as indeed it does; the worst time for a sufferer from bronchial asthma is usually in the early hours of the morning.

The circulation of Qi represents the traditional Chinese view of the biological clock within all of us, and, in the light of current medical knowledge, it is interesting to note how accurate are some of their observations.

George Lewith attended Trinity College, Cambridge and Westminster Hospital Medical School. He has worked as a Senior House Officer and Registrar within the Westminster and University College Hospital Teaching Groups in......more

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